Superseding Stress
Copyright Rabbi Eli Hecht
No part of this arcticle may be used or reproduced in any form without written permission from the copyright holder, except for brief quotations in reviews.
A well-known story is told about two psychiatrists who shared an office in a medical building. After a full day of work, the older, senior doctor of some 40 years practice, was found looking full of vigor and on the go. The younger doctor looked tired and seemed to be in a perpetual state of fatigue. It so happened at the end of a day's work that they both met in the elevator. The young doctor blurted out his feelings of wonderment, amazement as to how the elder can keep on going with his practice year after year and yet stay looking so healthy, while he, a younger man, after his daily 4. hour sessions would be completely drained, etc. The older psychiatrist smiled and said, "Who listens?"
We are told that stress is terrible and a cause for unproductively leading to destruction. Stress - pressure - strain - tension are well known to us and are no longer considered unusual phenomena. However, how do we deal adequately with stress or rather, how do we live with stress? Is there a healthy stress known as a good stress factor? Can we supersede stress?
Let me make a pint by telling you the following anecdote. A young surgeon, when meeting his patient, observed the patient trembling with fear, her knees knocking, and a general nervousness. The doctor asked his patient, Mrs. Greenberg, what her problem was. She then answered that in all her 70 years she never went under the knife and, therefore, this was her first operation. The doctor smiled and said, "Mrs. Greenberg, look at the palms of my hands; they are dry. Look at my forehead; it is dry. You see my hands don't tremble and it's my first operation, too"&The above story is definitely not a model story for dealing with stress.
There are many kinds of doctors, leading us from the ancient witch doctors to the brilliant, experienced head of medicine. There is a sensitive doctor and a callous doctor and, of course, a successful doctor. We are talking today of how to make a successful sensitive doctor remain successful and, that is, by not letting stress get to him.
I think that in almost every case of a doctor-patient relationship, we can describe the following formula. When a physician meets a patient the following occurs:
1. Appraisement
A. Evaluation - Understanding
B. Estimation -
2. Apprehension
A. Concept -
B. Perception - Appreciation
C. Image -
3. Expectation
A. Notion - Anticipation
B. Prospect -
When dealing with a patient, an appraisement is made and the doctor has the choice to continue with some apprehension and then concluding with an expectation - a prospect and anticipation of a cure. However, when the patient does not fulfill the expectation of the doctor, the notion of not healing this person causes stress and discomfort in the physician. After all, he treated the problem; he anticipated that a cure should have followed. However, lo and behold, it didn't. Of course, the doctor now would feel a sense of failure.
At this time, one must reexamine the three steps of appraisement, apprehension and expectation; meaning the understanding, appreciation and anticipation. At this time of cognizance, the doctor's main thrust should now be an emphasis on step one, reappraisement, and then step two, a new apprehension and appreciation. Step three, the expectation, is not where the emphasis should be put. The emphasis lies not in the expectation of what is suppossed to take place or should have taken place, etc. Truthfully, a doctor must realize that the patient contributes and plays a major role in the treatment. There are certain factors that must be recognized. What is the patient's real attitude; meaning, a) does he want to be healed, b) does he believe he can be healed, c) does he believe in the doctor's prognosis, d) does he want sympathy or a cure. These contributing factors are most important to healing. The above mentioned attitudes can never be controlled by the physician. As a matter of fact, a patient may really be fighting his doctor without verbalizing his feelings. How many times have we been told of the patient's drug abuse, etc.? So, how in the world can the doctor ever place his own integrity on the line when the situation is out of his control. The doctor who gets hung up on the expectation is literally setting himself on trial by locking himself into expectations which, in essence, cannot be truly dictated, as stated above. The doctor who stresses a very high expectation will be a doctor with a high rate of stress and will not be able to cope.
On the other hand, a doctor who has no real big expectations and lives with very little anticipation and puts no stress on perception, but bases all on his initial appraisement will not have that much stress because he will continue to reevaluate without the burden of appreciation and living up to some kind of expectation. Subsequently, he becomes a callous doctor who does an evaluation and avoids any expectation. He will, of course, have no stress, but then again, as in the story of the psychiatrist who didn't listen, there will be a great deal lacking. He will be a healthy doctor but a miserable specimen of a healer!
We mustn't become over-stressful by building up expectations and, yet, we must keep some degree of expectation. We must be able to stay in the middle in order to preserve our equilibrium. This art cannot be taught but must be learned.
Our great doctor and teacher, Moses Maimonides, said in the Book of Knowledge (Law 1-5), "Every human being is characterized by numerous moral dispositions which differ from each other and are exceedingly divergent. To cultivate either extreme in any class of dispositions is not the right course nor is it proper for any person to follow or learn it. The right was is the mean in each group of dispositions common to humanity; namely, that disposition which is equally distant from the two extremes in its class, not being nearer to the one than to the other. Hence, our ancient sages exhorted us that a person should always evaluate his dispositions and so adjust them that they shall be at the mean between the extremes, and this will secure his physical health."
With the above in mind, we return to our original questions: How do we deal with stress? How do we use stress? Is there healthy stress? I say we supersede stress - recognize stress for what it is - a stepping stone for something higher, a force that demands human accomplishment, an ascendant towards better humanistic traits cultivated by people of the professions, etc. As we are exposed to stress, we understand it is only temporary and creative. Consequently, we supersede the stress.
Perhaps by channeling our energies into more creative and positive thinking&A story is told by our ancient philosophers about two wise men observing a burning home. One of the occupants was seen fleeing for his life. Said one wise man, "Do you see how much that person doesn't want to get burned?"
"No," answered the other wise man, "I see how much he wants to live."
This is a classic example of an observation made by two people under the same circumstances yet one reflects an optimistic thinking while the other is quite pessimistic. He doesn't want to get burned more than he wants to live.
It would be foolish for us to imagine that when the doctor hangs up his jacket and stethoscope and puts away his prescription pad, he is no longer a doctor and can leave in a jolly, good mood. This total divorcement is impossible, and trying to achieve that goal will only lead to frustration because it is an unobtainable goal. As Maimonides says, you must not get carried away in extremes. A doctor is always on call, as the Hippocratic oath says, but in moderation. Yes, in every situation we must learn to discipline our thinking to reevaluate, to understand and to appreciate, but we must be careful in what to anticipate.
I will conclude by quoting Maimonides once again, "Medicine is an important introduction to the virtues and the knowledge of G‑d and for the attainment of real happiness."